¿Hay suficiente número de plazas hospitalarias para las prácticas de nuestros alumnos de Formación Profesional / Do we have sufficient hospital placements for our pathology technician trainees?

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Aerodigestive Programs Enhance Outcomes in Pediatric Patients.

The early efforts of pediatric airway surgeons, gastroenterologists, and pulmonologists to optimize surgical outcomes involved evaluating multiple organ systems for diseases negatively affecting surgery. This resulted in coordinated clinics with multiple services, ancillary testing, and endoscopic procedures, known as aerodigestive programs. These programs have nationally increased the value of care, with multidisciplinary experts delivering organized and efficient care to children with complex needs. This article describes the origin and value of aerodigestive programs within the modern health care landscape, serving as a primer for providers and administrators investigating how to facilitate aerodigestive or similar programs.

Women in Rural America Are Losing Hospital-Based Obstetric Services.

Isolated counties with low populations are most affected.

Análisis de la eficiencia técnica en los hospitales del Sistema Nacional de Salud español / Analysis of the technical efficiency of hospitals in the Spanish National Health Service

Objetivo: Analizar la eficiencia técnica y la productividad de los hospitales generales del Sistema Nacional de Salud (SNS) español (2010-2012) e identificar variables hospitalarias y regionales explicativas. Métodos: Se estudian 230 hospitales del SNS mediante análisis envolvente de datos midiendo la eficiencia técnica global, pura, de escala, y el índice de Malmquist. La robustez del análisis se evalúa con modelos input-output alternativos. Se emplean modelos multinivel lineales transversales de efectos fijos para analizar las variables explicativas de eficiencia. Resultados: El índice medio de eficiencia técnica global (ETG) es de 0,736 en 2012, con una importante variabilidad por comunidades autónomas. El índice de Malmquist (2010-2012) es de 1,013. Un 23% de la variabilidad en ETG es atribuible a la comunidad autónoma. Las variables exógenas estadísticamente significativas (residentes por cada 100 facultativos, índice de envejecimiento, renta media anual por hogar, gasto en servicios públicos fundamentales y gasto público sanitario per cápita) explican el 42% de la variabilidad de ETG entre hospitales y el 64% entre comunidades autónomas. El número de residentes es estadísticamente significativo. En todas las comunidades autónomas existe una relación lineal directa significativa entre la ETG y la renta anual per cápita y el gasto en servicios públicos fundamentales, e indirecta con el índice de envejecimiento y el gasto público sanitario per cápita. Discusión El importante margen de mejora en eficiencia de los hospitales está condicionado por características específicas de cada comunidad autónoma, particularmente el envejecimiento, la riqueza y las políticas de gasto público de cada una (AU)

Objective: To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010-2012) and identify explanatory hospital and regional variables. Methods: 230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models. A fixed effects multilevel cross-sectional linear model was used to analyse the explanatory efficiency variables. Results: The average rate of overall technical efficiency (OTE) was 0.736 in 2012; there was considerable variability by region. Malmquist index (2010-2012) is 1.013. A 23% variability in OTE is attributable to the region in question. Statistically significant exogenous variables (residents per 100 physicians, aging index, average annual income per household, essential public service expenditure and public health expenditure per capita) explain 42% of the OTE variability between hospitals and 64% between regions. The number of residents showed a statistically significant relationship. As regards regions, there is a statistically significant direct linear association between OTE and annual income per capita and essential public service expenditure, and an indirect association with the aging index and annual public health expenditure per capita. Discussion: The significant room for improvement in the efficiency of hospitals is conditioned by region-specific characteristics, specifically aging, wealth and the public expenditure policies of each one (AU)

Evaluación del equipo de complemento del Hospital Clínic de Barcelona / Evaluation of the additional equipment of Hospital Clinic of Barcelona

OBJETIVOS. Describir la opinión de las enfermeras del Hospital Clínic de Barcelona (HCB) acerca del equipo de complemento (EC), valorar la necesidad de formación específica y especialización para los profesionales que forman parte del EC, desde el punto de vista del resto los profesionales de enfermería del hospital, y determinar el nivel de satisfacción y conocimiento del enfermero del equipo de parada cardiaca (el enfermero del equipo de parada es un profesional del EC). METODOLOGÍA. Estudio descriptivo transversal de mayo de 2014 a febrero de 2015. Se obtuvieron datos mediante la distribución de una encuesta anónima a los profesionales de enfermería del hospital con más de 5 años de antigüedad que no forman parte del EC. RESULTADOS. El EC está considerado un servicio del HCB con identidad y organización propia en un 80 %. Un 94 % piensa que es un servicio necesario y un 96 % que está formado por profesionales capacitados y preparados para realizar las funciones de enfermería. Un 78 % opina que deberían recibir una formación continuada. Un 96 % sabe que la enfermera o enfermero del equipo de parada es un profesional del EC y lo valora con un alto grado de satisfacción CONCLUSIONES. El EC, a pesar del paso del tiempo y de los cambios sucedidos en nuestro Hospital, se valora como un modelo de cobertura necesario y con una identidad propia, formado por unos profesionales capacitados, preparados y reconocidos por el resto de profesionales de enfermería del hospital, que asumen de manera eficaz otras funciones como la del equipo de parada cardiaca del hospital (AU)

OBJECTIVES. To describe the opinion of nurses about a non-specialized in hospital support team called Equipo de Complemento (EC), evaluate the perception of other nurses about their need of additional formation -since those nurses are responsible for the cardiac arrest call-, and define the opinion of other staff about their knowledge and satisfaction about this duty. METHODOLOGY. This is a cross-sectional study performed from May of 2014 to February 2015. Data was collected through an anonymous poll, which was given to the hospital nursery professionals with more than 5 years of service. The respondents were not taking part in EC. RESULTS. The 80 % of the respondents think of EC as a hospital service of identity with self-organization. A 94 % believe that EC is really necessary, and 96 % of the respondents thinks that EC is composed of trained professionals ready to do nursery tasks. 78 % of the professionals believe that EC nurses should receive continuing education. Finally, 96 % of the respondents know that the cardiac arrest nurse is a member of EC, and they rate these nurses with a high degree of satisfaction. CONCLUSION. The EC is seen as a needed model with self-identity, composed of trained professionals. The hospital professionals of Nursery are really satisfied of their job. EC take part in other tasks as cardiac arrests and are highly rated for this duty (AU)

Simulación médica en punción aspiración con aguja fina utilizando maniquíes. Experiencia docente universitaria / Medical simulation training in fine needle aspiration cytology using phantoms. University teaching experience

Introducción. La punción aspiración con aguja fina (PAAF) es un procedimiento diagnóstico mínimamente invasivo y extremadamente útil para tipificar lesiones. La limitación de medios en las prácticas de anatomía patológica ha dificultado su enseñanza. Describimos la incorporación de maniquíes diseñados para realizar PAAF en nuestro centro. Material y métodos. Los maniquíes consisten en 2 simuladores de tareas, artesanales y a tamaño natural, de las regiones facial/cervical (modelo de utilidad U201500372) y de torso, respectivamente, revestidos por silicona, simulando piel, con áreas tumorales. Permiten realizar PAAF (palpación, punción, aspiración, obtención de material y extensión sobre portaobjetos) y son reutilizables. La práctica se realizó durante 3 cursos académicos (2013-2016) y consistió en realizar PAAF de manera individualizada sobre contexto clínico, con ulterior correlación citológica. Resultados. Un total de 178 estudiantes de medicina de la Universidad de Murcia de tercer curso realizaron la práctica (28 grupos: 105 mujeres, 73 hombres). La tasa de acierto (punción, aspiración de material y extensión en portaobjetos) fue del 97,2% con la primera punción. Además, 13 estudiantes procedentes de otras 10 universidades (nacionales e internacionales) llevaron a cabo la práctica, refiriendo la no existencia en sus centros de procedencia. Fue considerada como de gran valor sobre encuesta anónima. Discusión. Las prácticas de PAAF son fácilmente implementables y potencialmente incorporables a los formatos evaluativos tipo examen clínico objetivo estructurado (ECOE). No existe una adecuada estandarización en las prácticas de diferentes centros universitarios. Las prácticas de PAAF mejoran la formación del estudiante y proporciona un mayor conocimiento y una mejor consideración de nuestra especialidad (AU)

Background. Fine needle aspiration cytology (FNAC) is a minimally invasive and extremely useful procedure. The characteristics of the practice of pathology, together with limited equipment, make teaching this technique difficult. We therefore have introduced phantoms designed to perform FNAC as part of the medical education programme in our hospital. Material and methods. Phantoms are two life-sized hand-made reproductions of an adult head & neck (utility model ES1140059) and a trunk, respectively, coated with silicone simulating skin and with inserted tumor areas. They allow the whole FNAC process (palpation, puncture, aspiration, placement of material on slide and smear preparation) to be performed and, furthermore, are reusable. During 3 academic years (2013-2016) FNAC samples have been obtained in this way by each student individually, in a clinical context and with subsequent cytological correlation. Results. A total of 178 third year medical students from the University of Murcia, Spain, took part in the FNAC training programme (28 groups: 105 women, 73 men). The success rate in the first attempt (puncture, aspiration of material, placing and extending the obtained material on slides) was 97.2%. Furthermore, 13 students from 10 other universities (national and international) also took part, not having such a programme in their medical schools. In an anonymous survey the consensus was that it was valuable practical training. Discussion. Training in FNAC techniques is easy to include in the undergraduate curriculum and also in the Objective Structured Clinical Examination (OSCE) evaluation format. There is no proper standardization in training among different universities. FNAC simulation provides students with greater knowledge and appreciation of our specialty (AU)

Modelamiento del proceso clínico para manejo de usuarios con cáncer tiroideo diferenciado en el Hospital Base Valdivia, Chile / Modeling a clinical process for differentiated thyroid cancer health care in Hospital Base Valdivia, Chile

Objetivo. Modelizar el proceso clínico para la asistencia a pacientes con cáncer tiroideo diferenciado, con el fin de mejorar la accesibilidad a este tratamiento. Material y métodos. En función de la metodología de investigación acción participativa modificada se realizó la modelización del proceso a partir de revisión bibliográfica y de reuniones con las entidades comprometidas para el rediseño de proceso, hasta consensuar un proceso mejorado y factible. Resultados. Se modelizó participativamente el mapa del proceso, la caracterización de la cadena de valor, los fallos en la fluidez del proceso, los documentos relevantes, la propuesta de modificaciones del proceso y las autorizaciones correspondientes para mejorar el proceso. Se establecieron las vinculaciones del proceso principal con los procesos de soporte y estratégicos. La modelización participativa contribuyó a acortar los tiempos de espera entre el diagnóstico y el tratamiento de esta enfermedad de 12 a 4 meses. Conclusión. Que cada unidad pueda visibilizar completamente el mapa del proceso y entender su aporte como un conjunto de aportes integrados, y no fragmentados, ayudó al manejo integral de los pacientes y al funcionamiento institucional basado en los procesos, en un modelo organizativo jerarquizado y preponderante en los hospitales chilenos. Analizar y remodelar los procesos clínicos de manera participativa puede evitar fallos en la fluidez en la atención a los pacientes, al presentar a cada unidad participante la visión general del proceso, los problemas y las posibles soluciones. Asimismo, este enfoque puede contribuir a clarificar el proceso para hacerlo más eficiente, a armonizar las relaciones interpersonales y a mejorar la coordinación para optimizar la atención de los pacientes (AU)

Objective. To design a clinical process model in the management of differentiated thyroid cancer in order to improve accessibility to this treatment. Material and methods. Based on modified Participatory Action Research, a model design process was conducted using a literature review and meetings with organisations committed to the redesigning process, and to agree an improved and feasible process. Results. The process map was constructed by participatory action including, characterisation of the value chain, fault detection in the flow of the process, relevant documents and process for proposing modifications and approvals necessary for this purpose. Links were established between the main process and the support and strategic processes. The participatory model helped to cut the waiting times for diagnosis and treatment of this disease from 12 to 4 months. Conclusions. For each unit to be able to fully visualise the map of the process and understand their contribution as a set of integrated contributions and not fragmented, helps in the comprehensive management of patients and operation processes based on the hierarchical and dominant organisational model in Chilean hospitals. To analyse and remodel clinical processes by participatory action helps to limit failures in the fluidity of care of the patients, by presenting each participating unit with a general view of the process, the problems, and the possible solutions. Furthermore, this approach helps to clarify the process in order to make it more efficient, to harmonise relationships, and to improve coordination in order to optimise patient care (AU)

Experiencia de unidad de soporte a las segundas víctimas (USVIC) / Experience of a second victims support unit (USVIC)

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The changing role of ancillary health care service providers: an evaluation of Health Diagnostic Laboratory, Inc.

In an effort to reduce cost and improve quality, health care payers have enacted a number of incentives to motivate providers to focus their efforts on achieving better clinical outcomes and reducing the prevalence and progression of disease. In response to these incentives, providers are entering into new arrangements such as accountable care organizations and patient-centered medical homes to redesign delivery processes and achieve quality and cost objectives. This article reports the results of a study designed to evaluate the impact on cost and quality of care resulting from services provided by Health Diagnostic Laboratory, Inc., a clinical laboratory with a comprehensive care model. The results show that patients who utilized these laboratory services experienced lower total cost of care (23% reduction, P<0.01) and improved lipid profiles during the follow-up period. Total cost reductions were related to cost reductions found in both inpatient and ambulatory care. These findings suggest that accountable care organizations, patient-centered medical homes, and other groups entering shared savings initiatives should consider the potential role ancillary service providers with comprehensive care models can play in the delivery of integrated care.

The application of hospitality elements in hospitals.

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

An overview of Afghan National Army critical care capabilities.

BACKGROUND: The North Atlantic Treaty Organization created the International Security Assistance Force to help support the growth in capacity and capability of Afghan National Army (ANA). OBJECTIVE: This article describes the current critical care capabilities of the ANA, which was supported by embedded medical mentors to help build up Afghanistan's medical infrastructure after the fall of the Taliban. DESIGN: We reviewed the experiences of deployed medical mentors in ANA hospitals to report the progress and limitations of the North Atlantic Treaty Organization medical mentoring mission. RESULTS: From October 2008 through November 2009, the continued development of ANA Intensive Care Unit capabilities has decreased mortality from 26.3% to 5.1% despite an increase in admissions from 19 to 78 per month. CONCLUSIONS: Significant progress was made in the critical care capabilities of the ANA critical care physicians. The medical mentoring mission is an effective weapon in building the health care capacity of the ANA medical system.

A hospital-based patient and family education center: if you build it, will they come?

Librarians located in a 560-bed, inner city academic medical center with 25,000 + admissions per year planned and opened a Patient and Family Education Center (PFEC) in the lobby of a new patient care pavilion. A review of use in the first 19 months revealed that expected needs were being met while a variety of unexpected needs were identified. Ongoing use continues to be monitored by a detailed log of patron visits maintained by library staff. This article describes the evolution of the Patient and Family Education Center, outreach to the hospital community, and plans for the future.

A nutrition support service web application to manage patients receiving parenteral nutrition.

Parenteral nutrition (PN) is a complex therapy that requires expertise and experience to avoid errors in prescribing and management. Because of care coordination issues, one medical center has developed and implemented a Web-based application to manage PN patients. PN orders have already been programmed into the physician order entry system, but the nutrition support service (NSS) consult and daily PN management have been performed using paper forms. The Web system is developed for ease of use by clinicians and accessibility at any computer within the medical center. The database consists of 12 tables interrelated by the patient medical record number, admission number, or location. The NSS consult is the main table used to navigate to the other tables. Update of the laboratory and PN formula table must be done through the consult table. The system is compliant with the Health Insurance Portability and Accountability Act guidelines, and has been developed so that the forms that are required to be placed in the patient's permanent record can be printed. Demographic information and laboratory data are automatically populated via a link to the medical center's medication management system. At present, there are 1393 patients in the database and 21,000 pages are viewed each month during daily PN management by clinicians. Data can be easily retrieved for management reports. Data elements can be exported directly from the database to worksheets. This function has been used for projects designed to improve the efficiency of this PN system.

Legal issues affecting ancillaries and orthopedic practice.

The federal and state governments have imposed significant regulations on health care generally and on ancillary services in particular. This article focuses on how state and federal laws shape the ability of an orthopedic physician to offer ancillary services, whether as an individual, through a group practice, or as part of a joint venture. It focuses on how the Stark law, the Medicare anti-kickback statute, state anti-kickback, fee-splitting provisions, certificate of need laws, and various Medicare billing and supervision requirements impact the provision of ancillary services. It also briefly discusses how physicians should prepare for and respond to government investigations.

The transfer of a health insurance/managed care business.

The owners of a health insurance/managed care business may want to sell that business for a variety of reasons. Health care provider systems may want to exit that business due to operating losses, difficulty in complying with regulations, the inherent conflict in operating that business as part of a provider system, or the desire to focus on being a health care provider. Health insurers/HMOs may want to sell all or a portion of their business due to operating losses, difficulty in servicing a particular market, or a desire to focus on other markets. No matter what reason prompts a seller to undertake a sale, a sale of health insurance/managed care business can be a complicated transaction involving a multitude of issues. This article will focus first on the ways in which such a sale may be structured. The article will then discuss some transactional issues that may arise in the negotiations for the sale of a health insurance/managed care business. The article will then focus on some particular legal issues that arise in each sale-e.g., antitrust, HIPAA, regulatory approvals, and charitable issues. Finally, this article will provide an overview of tax structuring considerations.

Outsourcing and its implications for hospital organizations in Turkey.

To thrive in this era of global competition, all organizations must explore new managerial approaches to get an edge in the marketplace. One increasingly appealing approach is outsourcing. Hospitals are particularly fertile environments for outsourcing, given their role as providers of a broad and complex array of services, many of which may be bought from other institutions. The purpose of this study is to determine the types of services that hospitals in Turkey buy from other organizations. The study sample included 14 university hospitals, 20 Ministry of Health Hospitals, 15 Social Insurance Organization Hospitals and 31 private hospitals in Istanbul, Ankara, Izmir, Antalya, and Eskisehir, which are the biggest cities in Turkey. The following services were found to be outsourced: hospital management information systems (83.8%), cleaning services (81.3%), maintenance services (72.5%), leased medical devices (75.0%), food services (60.0%), patient direction services (63.8%), magnetic imaging services (60.0%), other imaging services (48.8%), laboratory services (42.5%), security services (38.8%), laundry services (36.3%), patient transportation services (33.8%), accounting services (26.3%), ambulance services (22.5%), patient satisfaction measurement services (13.8%), consultancy services (12.5%), and financial and investment services (9.5%). Private hospitals bought more services than public facilities did. The sampled hospitals chose to outsource services in order to decrease costs (78.8%), increase the quality of services rendered (65.5%), increase flexibility and share risk (36.6%), and increase profits (11.2%). The results of this study suggest that outsourcing, when applied judiciously through cost and risk analysis, is a cost-effective approach that can be used by most hospitals.